Every woman experiences her midlife years differently. The changes that occur during this period, including changes in sexual well-being, are typically caused by a mix of both menopause and aging, as well as by typical midlife stresses and demands.

Definitions. Before we get started reviewing the midlife changes that can sometimes wreak havoc on a woman’s sex life, let’s define a few terms:

Menopause is the final menstrual period, confirmed after 12 straight months without a period or when both of a woman’s ovaries are removed or permanently damaged. When menopause occurs naturally (not as a result of surgery or other medical intervention), it’s called "natural menopause." Most women experience natural menopause between ages 40 and 58; the average age in the
developed world is 51.

Perimenopause is the transitional time immediately before natural menopause when the changes of menopause begin, and includes the 12 months after (also called “the menopause transition”). Perimenopause can last 6 years or more.

Postmenopause is all the years beyond menopause.

Physical signs of menopause—also called perimenopausal changes—usually start during a woman’s 40s but may start earlier. Many women who experience natural menopause, however, report no physical changes during perimenopause except for irregular menstrual periods that eventually stop when menopause is reached. For other women, the irregular menstrual periods of perimenopause are accompanied by hot flashes, trouble sleeping, and/or vaginal dryness.

Many of these changes are not caused solely by menopause; most result from a mix of menopause and aging, while some are due to aging alone.

These and other midlife changes discussed in this section can affect your sex life and sexual function, sometimes causing distress for you and your partner.

A word about myths. Some women believe that a bit of hair thinning or an expanding waistline is a sure sign that menopause is at hand, but that’s often not the case. Despite myths to the contrary, many of the changes discussed here are not caused solely by menopause; most result from a mix of menopause and aging, while some are due to aging alone. When possible, we have tried to tease out how much menopause and aging contribute to the midlife changes discussed here. Keep in mind that the exact contribution of each factor is not completely understood.